title: Counseling, quality of life, and acute postoperative pain in elderly patients with hip fracture.
abstract: BACKGROUND
  Hip fractures represent one of the most important causes of morbidity and mortality in elderly people. Anxiety and depression affect their quality of life and increase pain severity, and have adverse effects on functional recovery. Recent World Health Organization guidelines emphasize that therapeutic regimes need to be individualized and combined with psychological support. This study was launched with the primary endpoint of assessing if and to what extent client-centered therapy affects the perception of pain, reduces anxiety and depression, and increases the quality of life of elderly patients with hip fracture.
  
  
  METHODS
  Forty patients were admitted to the Orthopedic and Trauma Surgery ward for hip fracture. Patients were randomly divided into two subgroups: (1) case (group C), had to receive patient-centered counseling throughout the hospitalization; and (2) control (group NC), receiving the analgesic treatment without receiving counseling. Short Form-36-item Health Survey Questionnaire, State-Trait Anxiety Inventory, and Hamilton Rating Scale for Depression scores were recorded before any treatment, at discharge, and after 30 days. Pain levels were evaluated by means of Visual Analog Scale every 12 hours during the hospitalization from the day of surgery until day 5.
  
  
  RESULTS
  The hierarchical clustering analysis identified before any treatment were two clusters based on different physical functioning perceptions and role limitations, which were due to physical and emotional problems. Counseling did have a positive impact on quality of life on all patients, but in a more relevant way if patients were low functioning upon admittance to the ward. Anxiety and depression decreased in patients undergoing counseling, and their pain levels were lower than among patients not receiving it.
  
  
  CONCLUSIONS
  This study reveals that hip fracture patients can be clustered on the basis of Short Form-36 baseline scores. Counseling affects the evolution of mental and physical status in these patients, and the major benefit is reported in patients whose quality of life perception is worse after the trauma. Decreasing anxiety and depression levels, as well as more satisfying pain management, assessed by means of specific tests, confirm the effectiveness of counseling in elderly patients with hip fracture.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Foggia, Foggia, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Gambatesa
authors.forename: Alessandro
authors.initials: A
authors.lastname: D'Ambrosio
authors.forename: Davide
authors.initials: D
authors.lastname: D'Antini
authors.forename: Lucia
authors.initials: L
authors.lastname: Mirabella
authors.forename: Antonella
authors.initials: A
authors.lastname: De Capraris
authors.forename: Salvatore
authors.initials: S
authors.lastname: Iuso
authors.forename: Antonello
authors.initials: A
authors.lastname: Bellomo
authors.forename: Antonio
authors.initials: A
authors.lastname: Macchiarola
authors.forename: Michele
authors.initials: M
authors.lastname: Dambrosio
authors.forename: Gilda
authors.initials: G
authors.lastname: Cinnella
keywords: cluster analysis; counseling; hip fracture; quality of life